MISSION STATEMENT

Disasters are a primary cause of morbidity and

mortality. Nurses can play an important role in
disaster mitigation, but they receive very little
training. This lecture is designed to help to
introduce to nursing the concepts of disasters and
disaster mitigation. We propose that you teach
this lecture to your nursing students to build
awareness world wide.

WHAT IS DISASTER

Is a result of vast ecological breakdown in the

relation between humans and their environment,
as serious or sudden event on such scale that the
stricken community needs extraordinary efforts
to cope with outside help or international aid.

TYPES
Natural
Pandemics
Transportation
Technological
Terrorism

HURRICANES
The primary health hazard from hurricanes or
cyclones lies in the risk of drowning from the
storm surge associated with the landfall of the
storm. Most deaths associated with hurricanes
are drowning deaths.
Secondarily, a hazard exists for injuries from
flying debris due to the high winds.

Nurses can be instrumental in providing direct

emergency care to drowning and head injuries.

TORNADOES

The primary hazard from a health perspective in a

tornado is the risk for injuries from flying debris.
The high winds and circular nature of a tornado
leads to the elevation and transport of anything that
is not fastened down. Most victims of tornadoes are
affected by head and chest trauma due to being
struck by debris or from a structural collapse. Some
individuals are injured while on the ground. Others
are lifted into the air by the tornado and dropped at
another location.

FLOODS

Floods may originate very quickly following a quick

rain storm, or they may develop over a short period
following an extended period of rain or quick snow
melt
The primary hazard from flooding is drowning
Longer term health concerns from flooding is the
development of disease from contaminated water and
lack of hygiene.

EARTHQUAKES
A significant global concern
The primary health concern:
Injuries arising from structural collapse
Most injuries occur amongst individuals trapped at
the time of the earthquake
Well known prevention strategy is to prevent
buildings from collapsing
There is a recognized need to develop better rescue
strategies for retrieving individuals from collapsed
buildings

VOLCANOES
Rare, but can be catastrophic when they occur
Over the 25 year period (1972-1996), there was
an average of 6 eruptions per year, causing an
average of 1017 deaths and 285 injuries
Health outcomes are associated with volcanic
eruptions:
Respiratory illnesses from the inhalation of
ash
For individuals close to the volcano, some
danger exists from lava flows, or more likely
mud flows

MAN-MADE THREAT
Unpredictable Challenges
Disruptive
Unexpected
Targeting weaknesses
Very rare, impossible to conceive before event
Threats to Civilians, Information
Infrastructure

COMPONENTS OF DISASTER DEBRIS

Building Debris
Household Debris
Vegetative Debris
Problem Waste Streams

MYTHS ASSOCIATED WITH

DISASTERS

Any kind of assistance needed in disasters

Epidemics and plagues are inevitable after every

disaster

Epidemics rarely ever occur after a disaster

Dead bodies will not lead to catastrophic outbreaks of exotic
disease
Proper resumption of public health services will ensure the
publics safety (sanitation, waste disposal, water quality,
and food safety)

Disasters bring out the worst in human behavior

A response not based on impartial evaluation contributes to

chaos

The majority responses spontaneous and generous

The community is too shocked and helpless

Cross-cultural dedication to common good is most common

response to natural disasters

PATTERNS OF MORTALITY AND

INJURY
Disaster events that involve water are the most
significant in terms of mortality
Floods, storm surges, and tsunamis all have a
higher proportion of deaths relative to injuries
Earthquakes and events associated with high
winds tend to exhibit more injuries than deaths
The risk of injury and death is much higher in
developing countries at least 10 times higher
because of little preparedness, poorer
infrastructure.

DISPLACEMENT OF DISASTER
VICTIMS
Mass Shelters
Shelter management:

Organized team (chain)

Sleeping area and necessities
Water and food handling
Sanitation (toilets, showers,..)
Special care to children and elderly
Health services (physical, mental)

DISASTER AND HEALTH

In a major disaster water treatment plants,
storage & pumping facilities, & distribution
lines could be damaged, interrupted or
contaminated.
Communicable diseases outbreak due to:

Changes

affecting vector populations (increase

vector),
Flooded sewer systems,
The destruction of the health care infrastructure, and
The interruption of normal health services geared
towards communicable diseases

DISASTER AND HEALTH

Injuries from the event
Environmental exposure after the event (no
shelter)
Malnutrition after the event (feeding the
population affected)
Excess NCD mortality following a disaster
Mental health (disaster
syndrome)

MENTAL WELLNESS
Little attention is paid to the children
Listen attentively to children without denying
their feelings
Give easy-to-understand answers to their
questions
In the shelter, create an environment in which
children can feel safe and secure (e.g. play area)

MENTAL WELLNESS
In any major disaster, people want to know where
their loved ones are, nurses can assist in making
links.
In case of loss, people need to mourn:
Give them space,
Find family friends or local healers to encourage
and support them
Most are back to normal within 2 weeks
About1% to 3%, may need additional help

THE MOST VULNERABLE

THE PHASES OF DISASTER

Mitigation:
Lessen

the impact of a disaster before it strikes

Preparedness:
Activities

strikes

undertaken to handle a disaster when it

Response:
Search

and rescue, clearing debris, and feeding and

sheltering victims (and responders if necessary).

Recovery:
Getting

a community back to its pre-disaster status

MITIGATION

Activities that reduce or eliminate a hazard

Prevention
Risk

reduction

Examples

Immunization

programs
Public education

PREPAREDNESS

Activities that are taken to build capacity and

identify resources that may be used
Know

evacuation shelters
Emergency communication plan
Preventive measures to prevent spread of disease
Public Education

RESPONSE

Activities a hospital, healthcare system, or public

health agency take immediately before, during,
and after a disaster or emergency occurs

RECOVERY

Activities undertaken by a community and its

components after an emergency or disaster to
restore minimum services and move towards
long-term restoration.
Debris

Removal
Care and Shelter
Damage Assessments
Funding Assistance

WHAT IS TRIAGE?
French verb trier means to sort
Assigns priorities when
resources limited
Do the best for the greatest
number of patients

WHY IS DISASTER TRIAGE

NEEDED
Inadequate resource to meet immediate needs
Infrastructure limitations
Inadequate hazard preparation
Limited transport capabilities
Multiple agencies responding
Hospital Resources Overwhelmed

ADVANTAGES OF TRIAGE
Helps to bring order and organization to a chaotic
scene.
It identifies and provides care to those who are in
greatest need
Helps make the difficult decisions easier
Assure that resources are used in the most
effective manner
May take some of the emotional burden away
from those doing triage

WHO DECIDES IN TRIAGE

Nurses dont act for legal fears of being blamed
for deaths, and lack of clarity on where they fit in
the command structure
Nurses function to the level of their training and
experience.
If nurses they are the most trained personnel the
site, they are in charge.

ARE NURSES PREPARED??

ROLE OF NURSING IN DISASTERS

Disaster preparedness, including risk assessment
and multi-disciplinary management strategies at
all system levels, is critical to the delivery of
effective responses to the short, medium, and longterm health needs of a disaster-stricken
population.
International Council of Nurses (2006)

NURSES ROLES IN DISASTERS

Determine magnitude of the event
Define health needs of the affected groups
Establish priorities and objectives
Identify actual and potential public health
problems
Determine resources needed to respond to the
needs identified
Collaborate with other professional disciplines,
governmental and non-governmental agencies
Maintain a unified chain of command
Communication

COMMUNICATION IS A SUCCESS
KEY
Nursing organizations must have a
comprehensive and accurate registry for all
members
Have a structured plan:

Collaborate and coordinate with local authorities

Have a hotline 24x7
Inform nurses where to report and how (keep records)
Make sure have a coordinator to prevent chaos
Ensure ways to maintain communication between
nurses and their families

THE NEED FOR DISASTER NURSING

TRAINING
11 million nurses world wide:
Form the backbone of the health care system
Are the frontline health care workers who are
in direct contact with the public
Contribute to health of individuals, families,
communities, and the globe
Schools of nursing offer little or no information
on disaster nursing (WHO, 2008)
Shortage of trained instructors/faculty (WHO,
2008)

CORE COMPETENCIES IN DISASTER

NURSING TRAINING
Ethical and legal issues, and decision making;
Care principles;
Nursing care;
Needs assessment and planning;
Safety and security;
Communication and interpersonal relationships;
Public health; and
Health care systems and policies in emergency
situations
(WHO, 2008)

TOPICS THAT MUST BE COVERED

BY DISASTER NURSING TRAINING
Basic life support
System and planning for settings where nurses
work
Communications (what to report and to whom)
Working in the damaged facilities and with
damaged equipment
Safety of clients and practitioners
Working within a team (understand each
members role and responsibility)
Infection control
Mental and psychosocial support
(WHO, 2006)

SUPERCOURSE INITIATIVE

BUILDING DISASTER NURSING

SUPERCOURSE

BUILDING DISASTER NURSING

SUPERCOURSE

BUILDING DISASTER NURSING

SUPERCOURSE

Most of all, if gains in health and nutrition during

emergencies are to be sustained, graduates need to
understand the importance of capacity building of
national staff and institutions.

Salama et al, Lessons Learned from Complex Emergencies

DISASTER NURSING SUPERCOURSE

o To join the Nursing Supercourse, please visit
www.pitt.edu/~super1
or e-mail
super2@pitt.edu.
o Membership in the Global Health Network
Supercourse will allow you to receive free
Supercourse CDs, just in time lecture, and annual
prevention lectures
o Note: send this lecture to a friend button works
from PowerPoint slide show mode